title: Acute intoxication caused by overdose of flunitrazepam and triazolam: high concentration of metabolites detected at autopsy examination.
abstract: A 52-year-old woman was found dead on the floor of the living room on the first floor of a house, which belonged to the man with whom she shared the house. On visiting the site, her clothes were found to be undisturbed. Packages of flunitrazepam (Silece, 2 mg/tablet) and triazolam (Halcion, 0.25 mg/tablet) were found strewn around the victim. Toxicological analysis was performed, and the concentrations of flunitrazepam, triazolam, and their metabolites in the victim's blood and urine were measured by high-performance liquid chromatography coupled with photodiode array and mass spectrometry. A high blood concentration of 7-aminoflunitrazepam was detected (1,270 ng/g), and further metabolites such as 7-acetamidoflunitrazepam, 7-acetamidodesmethylflunitrazepam, and 7-aminodesmethylflunitrazepam were detected in the blood and urine samples. In addition, 4-hydroxytriazolam and α-hydroxytriazolam were detected in her urine at a concentration of 950 and 12,100 ng/mL, respectively.On the basis of the autopsy findings and toxicology results of high concentrations of both flunitrazepam and triazolam derivatives, the cause of death was determined to be acute intoxication from flunitrazepam and triazolam.
authors.affiliation: Department of Forensic Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. namera@hiroshima-u.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Namera
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Makita
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Saruwatari
authors.forename: Aiko
authors.initials: A
authors.lastname: Hatano
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiraishi
authors.forename: Masataka
authors.initials: M
authors.lastname: Nagao
mesh_terms: D014151:Anti-Anxiety Agents / Q000097:blood / Q000506:poisoning* / Q000652:urine; D002851:Chromatography, High Pressure Liquid; D062787:Drug Overdose; D005260:Female; D005445:Flunitrazepam / Q000031:analogs & derivatives* / Q000097:blood / Q000506:poisoning* / Q000652:urine; D053593:Forensic Toxicology; D006801:Humans; D013058:Mass Spectrometry; D008875:Middle Aged; D014229:Triazolam / Q000031:analogs & derivatives* / Q000032:analysis / Q000097:blood / Q000506:poisoning* / Q000652:urine
chemical_list: D014151:Anti-Anxiety Agents; D014229:Triazolam; C028638:alpha-hydroxytriazolam; D005445:Flunitrazepam; C028637:4-hydroxytriazolam; C036343:7-aminoflunitrazepam; C036342:7-aminodesmethylflunitrazepam